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C Guedon

Publications and source records attributed to C Guedon.

At least 19 recordsLinked to original sources
PubMed2003

[Plastic surgery procedures in the treatment of mediastinitis in adult].

Closed vacuum drainage is becoming the standard technique in most early postoperative mediastinitis, open wound treatment being only necessary in case of failure of the previous technique or in high grade mediastinitis. The reconstruction technique to be chosen depends on both resulting wound presentation after debridement and thorax morphology. Mediastinal dead space obliteration is a "sine qua non" for success often requiring multiple flap transposition. Since 1983, reconstructive procedures were carried out in 205 patients, of them 95 had bilateral pectoralis major turn-over transposition flaps on internal pedicules, following internal mammary artery coronary revascularisation in 45. Trapezius and latissimus dorsi were the next most used flaps. Transposition of the omentum although especially well suited for torpid wounds was to often precluded by bad abdominal risk factors. Conservative closed drainage salvaged by reconstructive procedures when necessary has greatly improved both survival and functional outcome of these patients.

Drainage↗
PubMed2002

Prognostic value of mandibular involvement in oral cavity cancers.

OBJECTIVES: The aim of the study was to determine, in a homogeneous population, the prognostic impact of mandibular involvement in oral cancers. STUDY DESIGN: Retrospective study of 117 patients with T4 squamous cell carcinoma of the oral cavity treated by surgery and radiotherapy in the ENT Department of Bichat-Claude Bernard Hospital. All patients had histologically confirmed mandibular involvement. Patients with partial involvement of the mandible underwent rim mandibulectomy (RM) and those with extensive invasion underwent segmental mandibulectomy (SM). METHODS: The local failure rate and the overall survival curves were calculated with respect to type of mandibulectomy. The causes of death were analysed. RESULTS: The surgery was conservative in 55 cases (47%) and segmental in 62 patients (53%). The degree of mandibular involvement did not influence the local failure rate (29% and 25% in the RM and SM groups, respectively). On the other hand, it strongly influenced vital outcome, as five-year survival was only 25.4% after segmental mandibulectomy, compared to 40% after rim mandibulectomy. The metastases and the second primary tumors were more frequent in the SM group. CONCLUSION: The degree of mandibular invasion influenced the survival rate of patients with squamous cell carcinoma of the oral cavity but this difference is not due to local failure.

Adult↗
PubMed2001

Clinical, social and rehabilitation status of long-term home parenteral nutrition patients: results of a European multicentre survey.

BACKGROUND: Home parenteral nutrition (HPN) is a lifesaving treatment in patients with intestinal failure. Dependency of nutritional support becomes permanent for the majority of patients who had received HPN for at least 2 years. The alternative to long term HPN in selected patients is intestinal transplantation. AIMS: To study some of the clinical, social and rehabilitation aspects of long-term HPN treatment. METHODS: A survey was performed in nine European HPN centres. The questionnaire covered epidemiologic data, underlying diseases, intestinal anatomy, nutritional support and status, marital status, rehospitalization rate, HPN complications, rehabilitation score, drugs use, coexistent diseases and interest in intestinal transplantation. For some items, data were collected within 12 months prior to the evaluation. RESULTS: This survey included 228 patients with a median age of 49 years. The median duration of HPN was 7 years (range 2--24 years). Short bowel length less than 100 cm was reported in 65% of patients with a predominance of end-jejunostomy or jejuno-colonic anastomosis. Global subjective nutritional status was normal in 79% of the patients, who were supplied with a mean number of 5.6 bags of parenteral nutrition weekly. Rehospitalizations within the 12 months prior to evaluation accounted for a mean period of 23 days and were due to HPN complications in half of the cases. Catheter-related sepsis was the most frequent HPN-complication. Bone metabolism disorders, which seemed to be more common than liver diseases, were directly related to HPN duration. One-third of the HPN patients was regularly consuming analgesics or opiates. HPN impair complete rehabilitation status but may improve the status of patients who had a very low rehabilitation score before starting HPN. An interest of intestinal transplantation was noted in only 10% of medical teams and in 8% of HPN patients. CONCLUSIONS: This study is the largest European survey on long-term HPN patients with long standing or permanent intestinal failure. Data enlighten clinical, social and rehabilitation aspects of patients who could face the option of intestinal transplantation in the future.

Adult↗
PubMed2001

[Supraglottic laryngectomy with arytenoidectomy].

Relearning to swallow is frequently difficult after supraglottic laryngectomy requiring arytenoid cartilage resection. We propose a surgical procedure in which a local flap is used to close the pharyngeal defect without approximating the laryngeal remnants and the base of tongue. The procedure opens the median raphe and cuts the hyoid bone along the midline. The strap muscles, the perichondrium from the thyroid cartilage and thyroid lobe on the ispilateral side to the tumor are retracted laterally to be used to close the mucosal defect. Sixty-eight patients with T1-T3 carcinomas of the laryngeal margin with extension to an arytenoid in all cases and limited extension to the medial wall and/or anterior angle pyriform fossa in 33 underwent this surgical procedure. Only 5 patients had local recurrence and 8 a lymph node recurrence. Visceral metastases occurred in 21 patients (33%) and second primary tumors were diagnosed at the time of surgery or during follow-up in 19 patients (28%). Three and 5-year actuarial survival rates were 57 and 51%, respectively. Despite post operative radiotherapy, functional success was obtained in 50 patients (75%). This technique provided good tumor control and a high rate of satisfactory functional results in patients with tumors of lateral margin extended to one arytenoid.

Aged↗
PubMed2001

[Diagnostic value of needle biopsy and frozen section histological examination in the surgery of primary parotid tumors].

The necessity of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of parotid gland lesions is still controversial. We examined the accuracy of cytology and histology in a review of 128 parotid gland tumors who underwent surgery with FNAB, n = 102 and/or frozen section examination (FS), n = 94. The diagnostic sensibility and specificity for malignant or benign lesions was respectively 81.5% and 97.5% for FNAB and 75% and 100% for FS as compared with definite histology (110 tumors were benign and 18 malignant). Insufficient material for FNAB evaluation was found in 12 patients mainly with small tumors (p = 0.043) or with tumors located in the deep process of the parotid gland (p = 0.029). Surgery was inappropriate (superficial lobe resection for malignant tumor) because of 4 false negative FS diagnoses. FNAB offers valuable information in the diagnosis of nonsurgical lesions and permits to avoid FS if FNAB identify a benign lesion. FS remains mandatory if FNAB evaluation is not possible or suggests a neoplastic tumor.

Biopsy, Needle↗
PubMed2000

Prognostic value of lymph node involvement in oral cancers: a study of 137 cases.

OBJECTIVE: The aim of this study was to assess the prognostic value of lymph node involvement in patients with squamous cell carcinoma of the oral cavity. STUDY DESIGN: Retrospective study of 137 patients with T4 squamous cell carcinoma of the oral cavity treated by surgery and radiotherapy (84 N0, 23 N1, 16 N2,14 N3). Twenty-three patients in the N0 group had a history of surgery or radiotherapy. One hundred fourteen patients underwent limited or radical neck dissection unilaterally or bilaterally. METHODS: The histological charts were reviewed and correlated with preoperative lymph node clinical stage. The local failure rate and the overall survival curves were calculated with respect to clinical and histological stages. The causes of death were analyzed. RESULTS: No evidence of lymph node metastasis was found in 47.4% of cases (54 of 114 patients). Among the node-positive (N+) patients, 39 had rupture of the lymph node capsule (R+). In the N0 group, 27.8% of patients were N+. Regional control rates after surgery and radiotherapy were 95% at 1 year and 85.4% at 5 years. The local failure rates were 6% in N0, 8.7% in N1, 31.2% in N2, 51.7% in N3, 9% in node-negative (N-), and 29% in N+R+ patients. The overall survival rates at 3 and 5 years were, respectively, 44.7% and 34.8% in the N0 group, 37.7% and 37.7% (same rate at 3 and 5 years) in the N1 group, and 31.2% and 15.8% in the N2 group. None of the patients in the N3 group survived beyond 2 years. The overall survival rates at 5 years were 42.8% and 17.5% in the N- and N+ groups, respectively. CONCLUSIONS: In patients with locally advanced tumors (T4), clinical nodal status and histological nodal invasion were key prognostic factors. The presence of occult metastases in the N0 group justifies routine neck dissection.

Adult↗
PubMed2000

[Prognostic influence of cutaneous involvement in malignant tumors of the oral cavity].

The aim of this study was to assess the prognostic influence of cutaneous involvement in T4 squamous cell carcinoma of the oral cavity. The population was a homogeneous group of 137 patients. Cutaneous tumor localizations were observed in 20 of them. Surgery and radiotherapy were given in 103 cases and salvage surgery was performed in 34. Local control at 5 years was achieved in 68.5 % of the patients. Carcinologic failure rate was 55 % and 27.3 % in patients with and without cutaneous involvement respectively (p =0. 013). 5-year survivor rate was also correlated with cutaneous involvement: 10 % versus 32.2 % (p <0.0001).

Adult↗
PubMed2000

[Enteral nutrition: techniques and indications].

Enteral nutrition must be preferred to parenteral nutrition if case of intact digestive tract. Naso-gastric tubes are frequently used, particularly in enteral feeding. However, the use of naso-enteral tubes, i.e. naso-duodenal and naso-jejunal tubes, is expected to increase in the future. Their efficacy has been demonstrated in two specific cases: intensive care (post-operative or post-traumatic states), acute pancreatitis. A third potential use is in the replacement of a naso-gastric tube by a naso-jejunal tube in cases of frequent aspiration pneumonia related to a gastro-esophageal reflux. Gastro- and jejunostomies have to be indicated when enteral nutrition is thought to be used for more than one month. The insertion of a naso-gastric tube is generally performed by the nurse following medical guidelines and the insertion of a naso-jejunal tube is often done during an endoscopy by the physician. The verification of the correct position of the tube should preferably be done with an X-ray confirmation. However, this is difficult to perform at home and the most frequent method for control is the clinical method by auscultation. Enteral nutrients are generally polymeric and infused with gravity without a peristatic pump excepted in children. In conclusion, technical improvements in enteral nutrition have led to a simple, cost-effective and low risk methods of treatment.

Enteral Nutrition↗
PubMed1999

[Prospective evaluation of three kits for endoscopic percutaneous gastrostomy (PEG)].

OBJECTIVES: Percutaneous endoscopic gastrostomy (PEG) is often used for long-term enteral feeding. Various PEG kits are currently available. A technical evaluation could be useful in providing a criteria of choice between the different kits. METHODS: Therefore, from January 1995 to January 1998, we prospectively performed a short- and a mid-term technical evaluation of 150 PEG kits: 106 Compat Sandoz, 37 Flocare Nutricia et 7 Sherwood. RESULTS: In 20% of the patients studied, technical problems during endoscopic insertion of the probe were observed. Only minor incidents were found for Compat Sandoz and Flocare Nutricia kits. However, major problems occurred with the Sherwood kits leading to a very difficult (4 cases) or impossible (2 cases) transcutaneous introduction of the catheter into the stomach. Mid-term outcome was evaluated in 86 of the 150 patients (57%) with a median follow-up duration of 5 months (range: 1-24). The main finding of the mid-term evaluation was a significant alteration of the Compat Sandoz tube. CONCLUSION: This prospective evaluation shows that technical improvement of the available PEG kits are needed, that the PEG polyurethane tube could be preferred for long-term enteral feeding.

Aged↗
PubMed1999

[Endoscopic surgical treatment of Zenker hypopharyngeal diverticuli. Apropos of 59 cases].

We report our experience with 59 cases of Zenker's diverticulum, all treated endoscopically from 1979 to 1998. The ages ranged from 59 to 98 years. There were contraindications for conventional surgery or deep general anesthesia for all the patients. The surgical technique of endoscopic treatment was performed under general anesthesia, using a specially designed endoscope for exposure. Scissors, and after 1990 CO2 LASER, were used to divide the posterior cricopharyngeal muscle fibers. There was no major complication. Our results are comparable with literature, 92% success, even though a small diverticulum may paradoxically remain. Besides, from our experience, it may be necessary to perform two sessions for diverticulum larger than 3 cm. This safe and efficient treatment can be recommended for patients of all ages with a contraindication for conventional surgery.

Aged↗
PubMed1998

[A 1993-1995 epidemiological survey of home parenteral nutrition in approved centers for adults in France].

OBJECTIVES: A 1993-1995 three year epidemiological survey of home parenteral nutrition was performed through in France in approved centers for adults. METHODS: Data were retrospectively collected each year on a standardized questionnaire focussing on indications and short term outcome. RESULTS: All centers (n = 14) participated in the study and 524 new adult patients were recruited. The overall incidence was unchanged at 3.75 patients/10(6) adults. Indications for AIDS rose (8 to 18%) whereas other indications were stable. Prevalence increased by 19%: 4.40 adults/10(6) patients at 01.01.1996. At six months, the probability to stay on treatment was 19.5% for AIDS and cancer indications but 52% for others, whereas death rates were 59% and 9% respectively. CONCLUSIONS: For both cancer and AIDS indications, short-term treatment was due to a poor prognosis. For other diagnosis, complicated with a short bowel in 51% of cases, prognosis was excellent but associated with treatment dependency. The latter point focuses on the need for additional treatments in irreversible intestinal failure.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Endoscopic treatment of a Zenker diverticulum. 50 cases].

OBJECTIVES: Endoscopy has been used for many years as an alternative to surgery for the treatment of Zenker's diverticulum. We report our experience in 50 cases. METHODS: From 1979 to 1995, we treated 50 cases of Zenker's diverticulum endoscopically. Patients' age ranged from 59 to 98 years. All patients had contraindications for conventional surgery or deep anesthesia. The surgical technique of endoscopic treatment is performed under general anesthesia using a specially designed endoscope for exposure. Scissors, then after 1990, CO2 LASER, was used to divide the posterior crico-pharyngeal muscle fibers. RESULTS: There were no major complications. Our results, 95% success, were comparable with those reported in the literature even though, paradoxically, a small diverticulum may remain. Our experience also showed that it may be necessary to perform two sessions for diverticula larger than 3 cm. CONCLUSION: This safe and efficient treatment can be recommended for patients of all ages with a contraindication for conventional surgery.

Aged↗
PubMed1996

[Total glossectomy with laryngectomy].

Because local control of locally advanced cancer of base of tongue and larynx managed with combined chemotherapy and radiotherapy is poor, we proposed total glossectomy with total laryngectomy. Twenty-one patients underwent this operation over a period of 8 years. It was a salvage surgery for 15 patients, and an up-front surgery for the 6 others. Postoperative complications occurred in ten patients, and three patients died in the postoperative period. Mean total duration of hospitalisation was 40 days. Oral feeding could be achieved in 14 patients (mean delay: 46 days), but satisfactory oesophageal voice has never been obtained. We can conclude from the analysis of this series that total glossectomy with total laryngectomy is a heavy surgery, which leads to frequent complications, severe functional sequellae, and poor survival. However, control of pain can be obtained, that justifying this heavy procedure. We recommend that patients and relatives should be fully informed about the consequences of surgery before final decision.

Actuarial Analysis↗
PubMed1995

[Outcome of the surgery of cancers of upper respiratory and digestive tracts].

The best treatment for cancer of the head and neck remains surgery followed by radiotherapy. The surgical resection became progressively more conservative for tumor of the hypopharynx and larynx whereas resection of buccal and oropharyngeal tumors became more aggressive without adding extra mutilation. New reconstructive techniques have allowed both extended resection and reconstruction with a major concern for function and cosmesis. First to be used, myocutaneous flaps have remained the workhorse of reconstructive surgery for the head and neck, mainly because they are quick to harvest and less demanding than free flaps. Nevertheless microvascular skin, bone and digestive flaps, are becoming more and more widely used even though time consuming. This drawback is balanced by the high standard of reconstruction achieved by these flaps, allowing a shorter hospital stay and a quicker rehabilitation.

Humans↗
PubMed1995

Surgical treatment of carcinoma of the proximal esophagus.

BACKGROUND: Proximal esophageal cancer is usually diagnosed at an advanced stage, and the treatment is often limited to palliation. Surgery offers the best relief of dysphagia but it remains controversial, because a cure is unlikely even at the price of laryngeal mutilation. PATIENTS AND METHODS: We treated 40 patients with transhiatal esophagectomy for cancer of the proximal esophagus. The esophageal substitute was a stomach tube in 37 patients and colon in 3 patients. The larynx was preserved in 27 patients whose tumors did not extend to cricopharyngeus. Adjuvant treatment consisted of postoperative radiotherapy for 22 patients, chemotherapy for 1 patient, and a multimodality regimen for 4 patients. RESULTS: The postoperative complication and hospital mortality rates with gastric tube transpositions were 22% and 8%, respectively, with a 3% fistula rate. The 1- and 3-year overall survival rate was 53% and 21%, respectively. The unfavorable prognostic factors were tumor wall penetration, lymph nodal involvement, and cricopharyngeal involvement. Local recurrence of cancer was the major cause of failure. CONCLUSIONS: These results indicate that transhiatal esophagectomy with gastric tube transposition offers good palliation of dysphagia with low morbidity and mortality for proximal esophageal cancer. The laryngeal preservation can be attempted for tumors located close to, but not involving, the cricopharyngeus in order to retain speech in patients with a limited life expectancy.

Adult↗
PubMed1994

Gastric tube transposition for cancer of the hypopharynx and cervical oesophagus.

A study of 20 cases of gastric tube transposition following total laryngopharyngoesophagectomy during an eight-year period is presented. The site of the tumour was: hypopharynx in 13 cases (12 pyriform sinus, 1 post-cricoid); and cervical oesophagus in seven cases. There were nine (45 per cent) Stage III lesions and 11 (55 per cent) Stage IV lesions (UICC, 1987). Post-operative morbidity rate was 15 per cent. Hospital mortality rate was 10 per cent (cause of death was myocardial infarction). Anastomotic fistula rate was five per cent. Excluding hospital mortality, the three year actuarial survival rate was 35 per cent for the whole series and 53 percent for patients with hypopharyngeal cancer. The actuarial survival rate for patients with oesophageal cancer at one and two years was 41 and zero per cent respectively. The transposition of a tubed stomach provided successful swallowing in two-thirds of the patients for a period of more than a year and these patients developed good neoesophageal speech.

Adult↗